Provider Demographics
NPI:1528211380
Name:TAYLOR, EILEEN (RT RPA/RA)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RT RPA/RA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 NW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4068
Mailing Address - Country:US
Mailing Address - Phone:954-993-5855
Mailing Address - Fax:
Practice Address - Street 1:1400 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1003
Practice Address - Country:US
Practice Address - Phone:305-325-5916
Practice Address - Fax:305-325-4362
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
243U00000X
FLCRT63524247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant